Nick Heather PhD,Northumbria University

Presentation at INEBRIA2009,Newcastle/Gateshead, UK

8/10/09

INTRODUCTION TO THE CONFERENCE:BREAKING NEW GROUND IN THE STUDY

AND PRACTICE OF ALCOHOL BRIEF INTERVENTIONS

CURRENT SITUATION:The upside

Good evidence for the effectiveness of alcohol SBI, especially in primary health care

Increasing acceptance of the major contribution SBI can make to reducing alcohol-related harm

Growing interest by governments around the world in the potential of SBI as an effective and cost-effective policy against alcohol-related harm

CURRENT SITUATION:The downside

A necessary focus on testing the effectiveness of SBI has led to neglect of other important questions

Too much emphasis on meta-analysis?

Risk of complacency?

SPECIAL TOPICS (1)the theory of brief interventions;development and applications of SBI in the

criminal justice setting:brief interventions and the Internet;development, evaluation and

implementation of SBI among young people;

application of SBI to black and minority ethnic groups;

SPECIAL TOPICS (2)optimal forms of screening in various

medical and nonmedical settings;innovative ways of encouraging health

professionals to incorporate SBI in their routine work;

effective strategies for achieving integration of SBI in government policies;

applications of SBI in parts of the world where it has yet to make much impact.

HOW MANY FORMS OF BI ARE THERE?

Brief advice (+FRAMES) vs. motivational interviewing

But do they have different effects?

If so, does motivational interviewing add to the effects of brief advice?

If so, with whom and under what circumstances?

WHAT ARE THE LIMITS OF BI

Dichotomy of “dependent” vs. “non-dependent” unhelpful

At what point along the continuum of dependence and/or problem severity does BI become practically ineffective?

Is the dependence the only, or even the main factor determining the limit of BI effectiveness?

HOW FAR CAN EVIDENCE OF BI EFFECTIVENESS BE

GENERALISED?Good evidence for effectiveness in primary

health care (brief advice) and in higher educational settings (motivational interviewing)

But can this evidence be used to justify implementation on other settings?

NB. The extended precautionary principle

HOW DO BRIEF INTERVENTIONS WORK?

By increasing the number who try to cut down (without necessarily increasing the effectiveness of change attempts)?

Or by increasing the success rate among those who do try?

Theoretical bases:Stages of change (Prochaska & DiClemente);Outcome and/or efficacy expectancies (Bandura);Cognitive dissonance (Festinger);Self-affirmation (Harris).

More research needed!!!